Se-Won Lee

Postoperative alopecia in five patients after treatment of aneurysm rupture with a Guglielmi detachable coil: pressure alopecia, radiation induced, or both?

Postoperative pressure alopecia is an uncommon complication of long anesthetic surgical procedures, typically affecting the occiput and resulting from pressure‐induced tissue hypoxia. Generally, it develops after procedures of long duration, of more than four hours. Most alopecia is transient, but a few cases are permanent. Guglielmi detachable coil (GDC) coiling is a procedure guided by fluoroscopy that fills an intracranial aneurysm. Our cases were characterized by an unusual distribution of alopecia, short duration of procedure, and radiation exposure. The alopecic lesions of our patients were located on the temporal scalp as well as the occipital scalp. The total time of anesthesia was relatively short, two to three hours. During the procedure, these patients were exposed to ionizing radiation (over 2Gy). These cases are different from previous reports in that the duration of the procedure was short, the temporal scalp was affected in addition to the occipital scalp, and the pathology occurred after GDC coiling.

Does Decreased Meniscal Thickness Affect Surgical Outcomes After Medial Meniscectomy

Background: There have been no clinical studies regarding the effect of decreased meniscal thickness on outcomes after meniscectomy. Purpose: To examine the postoperative outcomes of partial meniscectomy with or without horizontal resection compared with the outcomes of subtotal meniscectomy and to evaluate the influence of decreased thickness of the medial meniscus on outcomes after partial meniscectomy. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 312 patients who underwent medial meniscectomy were retrospectively reviewed. Patients were divided into 3 groups: group A (n = 84) included patients with partial meniscectomy with vertical resection, group B (n = 140) consisted of those with partial meniscectomy with horizontal resection, and group C (n = 88) included those with subtotal meniscectomy. Clinical function was evaluated by use of the Lysholm knee scoring scale, International Knee Documentation Committee (IKDC) subjective knee evaluation form, and Tapper and Hoover grading system. Radiologic evaluation was performed with the IKDC radiographic assessment scale as well as with measurements of the medial compartment height at the tibiofemoral joint. Preoperative values and postoperative values measured 5 years after operation were assessed. Results: Functional outcomes in group C were inferior to those in groups A and B according to the Lysholm knee score (mean ± SD for group A = 96.1 ± 4.7, group B = 94.9 ± 5.2, group C = 84.8 ± 11.4; P < .001), IKDC subjective score (group A = 92.1 ± 6.5, group B = 91.3 ± 8.8, group C = 81 ± 11.4; P < .001), and Tapper and Hoover grading system (P = .003). There was no significant difference in scores between groups A and B. With regard to radiologic evaluation, the IKDC radiographic grade for group C was worse than the grades for groups A and B (P < .001); there was no significant difference between groups A and B. However, the postoperative joint space on the affected side was higher for group A (4.7 ± 0.6 mm) than for groups B (4.3 ± 0.5 mm; P < .001) and C (3.7 ± 0.8 mm; P < .001). The joint space was higher in group B than in group C (P < .001). Conclusion: Despite joint space narrowing, decreases in meniscal thickness after partial meniscectomy for horizontal tear had no additional adverse effect on 5-year functional and radiographic outcomes compared with conventional partial meniscectomy preserving whole meniscal thickness. In treating horizontal tears of the meniscus, partial meniscectomy with complete resection of the unstable leaf was an effective method in a 5-year follow-up study.

Short-term Outcomes of Ceramic Coated Metal-on-Metal Large Head in Total Hip Replacement Arthroplasty

Purpose This study characterizes the short-term outcomes of ceramic coated metal-on-metal (MoM) large head total hip arthroplasty (THA) in prospectively selected patients aged 70 to 75 years. Materials and Methods Eighteen patients (18 hips) between the ages of 70 and 75-years old with THA using ceramic-coated MoM large heads between June 2014 and December 2014 were evaluated. We prospectively selected patients younger than 70 years for bipolar hemiarthroplasty and older than 75 years for conventional THA. There were one case of osteoarthritis, 8 cases of femur neck fracture, and 9 cases of intertrochanteric fracture. All patients underwent clinical and radiological follow-up at 6 weeks, 6 and 12 months, and every year postoperatively. The mean duration of follow-up was 24.2 months (range, 18–34 months). Results The average Harris hip score at the final follow-up was 81.0, except one case which was ultimately converted to conventional THA due to acetabular cup loosening. Radiographically, mean acetabular cup inclination was 45.8°(range, 38–56°) and anteversion was 20.1° (range, 11–25°). The average femoral head size was 48.7 mm. All stems were neutral-positioned except 1 varus-positioned stem. There was 1 case of a soft tissue infection, 3 patients complained of persistent groin pain, and no dislocations occurred. Conclusion Ceramic coated large MOM articulation (ACCIS) have many complications: cup loosening, groin pain, which can lead to fatal outcomes in the elderly patients. Especially in patients with communicated intertrochanter fracture (AO 31-A22, 23), careful attention should be paid to the choice of surgical option.

Single-leaf partial meniscectomy in extensive horizontal tears of the discoid lateral meniscus: Does decreased peripheral meniscal thickness affect outcomes? (Mean four-year follow-up)

BACKGROUND To evaluate whether single-leaf partial meniscectomy in horizontal tears along the entire discoid lateral meniscus has any advantages in clinical and radiological results compared with other meniscectomies in discoid lateral meniscus. METHODS A total of 145 patients with a horizontal tear pattern in symptomatic lateral discoid meniscus were retrospectively reviewed. Twenty-seven patients had undergone full-extent single-leaf partial meniscectomy (group A), 60 had undergone conventional partial meniscectomy (saucerization) maintaining peripheral meniscal height (group B), and 58 patients had undergone total meniscectomy (group C). Each patient was evaluated with the Lysholm knee score, International Knee Documentation Committee (IKDC) subjective grading, and modified Kellgren-Lawrence grade in plain radiography at their last follow-up. RESULTS Group C had inferior functional results to groups A and B on the Lysholm knee score and IKDC subjective score. There was no significant difference between groups A and B. Group C fared significantly worse than groups A and B (p=0.003, p<0.001) by modified Kellgren-Lawrence grade. CONCLUSION With regard to clinical and radiological evaluations in lateral discoid meniscus tears, the full-extent single-leaf partial meniscectomy group had no adverse results compared with the total meniscectomy group and was not significantly different compared to the conventional partial meniscectomy group. STUDY DESIGN Cohort study. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Superior Gluteal Artery Pseudoaneurysm Caused by Pelvic C-Clamp Blind Application: A Case Report

To control such a hemorrhage, a displaced pelvic ring must be rapidly reduced and stabilized with a pelvic binder, an external fixator, or a pelvic clamp. Among them, pelvic clamps can be life-saving but pin malposition may cause vascular complications. We present a case of superior gluteal artery pseudoaneurysm caused by AO pelvic C-clamp pin malposition.

Primary total hip arthroplasty using modified posterior approach through quadratus femoris flap osteotomy; comparison with conventional posterior approach

Introduction The quadratus femoris muscle has not attracted attention as a structure for surgical exposure during posterior hip approaches. We sought to introduce a modified posterior approach through the quadratus femoris muscle area only, by flap osteotomy, which we have named the quadratus femoris osteotomy (QFO) approach. We compare this with the conventional posterior approach to determine the effectiveness of the new technique. Methods We retrospectively reviewed the medical records of 329 patients (383 hips) who had undergone primary total hip arthroplasty (THA) between March 2006 and January 2013 by a single hip surgeon. The conventional group consisted of consecutive 118 patients (138 hips) who had undergone THA using the conventional posterior approach. The QFO group consisted of consecutive 101 patients (120 hips) who were treated with THA using the QFO approach. Results The 2-year postoperative average Harris hip score were 88.8 ± 6.6 in the conventional group and 93.1 ± 6.9 in the QFO group. The 2-year postoperative average WOMAC scores were 20.8 ± 6.7 in the conventional group and 14.1 ± 6.6 in the QFO group. Complications in the conventional group were 2 deep vein thrombosis (DVT)s, 1 intraoperative fracture, and 6 posterior dislocations; the QFO group experienced 1 DVT and 3 intraoperative fracture. No dislocation was noted within 2 years after surgery. Conclusions Although further studies are needed to confirm the validity of our findings, a modified posterior approach using a quadratus femoris flap osteotomy could be an option worth considering among the variants of posterior approaches in THA.

Underestimated Sacroiliac Joint Lesion on Computed Tomography in Pelvic Open-book Injury: A Case Report

The classification of anteroposterior compression (APC) injury type is based on using static radiographs, stress radiographs are known as a useful adjunct in classifying type of APC pelvic injuries. According to a recent article, the intraoperative stress examination has led to a change in the treatment plan in more than 25% of patients on 22 patients presumed APC type I (symphyseal diastasis <2.5 cm) injuries. Here authors present a case demonstrating a necessity of intraoperative stress test for excluding concealed posterior ring disruption.

A Case of Pre‐Sézary Syndrome Preceded by Hand Lesions

Pre‐Sézary syndrome is an erythroderma with a chronic course, clinical findings of Sézary syndrome, lymphocytic subepidermal band infiltration at times, and repeated cycles of circulating Sézary cells of less than 1,000 cells/mm3. Duration of the pre‐existing skin diseases preceding pre‐Sézary erythroderma varies from a few weeks to 20 years. Before the erythroderma develops, these patients are diagnosed with contact dermatitis, neurodermatitis, chronic dermatitis, atopic dermatitis, or asteatotic eczema. Hand lesion also precedes the pre‐Sézary erythroderma. This condition has been controlled by three cycles of chemotherapy consisting of vincristine, Cytoxan, doxorubicin, and prednisolone. We describe a case of pre‐Sézary syndrome preceded by hand lesion and treated with chemotherapy.